Oddities, musings and news from the health world

Day-care practices of excluding sick kids are much too strict

April 19, 2010 | 9:08
am

One day, many years ago, I was called at work by my 2-year-old daughter's day-care provider and told to come and get her. She probably had an infectious childhood illness called hand, food and mouth disease, the director explained, because of the pinkish cracks in the palms of her hands.

I was fairly certain my daughter wasn't ill. However, I left work, picked her up and took her to the pediatrician, who glanced at her palms and said she had dry skin. I returned her to the sheepish day-care director and drove back to my office, thinking what a waste of time and money the morning had been for my employer and me. My daughter rather enjoyed the unplanned interlude, but I worried that she'd probably picked up some real illness at the doctor's office and would be vomiting by morning.

This experience, it turns out, is all too common. Despite detailed guidelines on illness from the American Public Health Assn. and the American Academy of Pediatrics, day-care centers routinely exclude children with mild illnesses, according to a study published Monday in the journal Pediatrics. The study polled 305 directors of day-care centers and presented them with scenarios of various illnesses, asking when they would exclude the child from care.

Researchers found that directors would unnecessarily exclude 57% of children with mild illnesses. Here are some of the scenarios in which the majority said they would exclude children but, under guidelines, do not warrant exclusion.

Three-year-old, clear, runny nose for five days, dry cough for three days, temperature normal, able to participate in usual activities.

Four-year-old, red eyes, clear drainage, temperature normal.

Two-year-old, toilet trained, vomited what she ate once and had two loose, watery stools in the toilet. Temperature normal.

Three-year-old, felt warm, fever of 101 taken under the arm, no other symptoms and "acting his usual perky self."

Four-year-old, circular rash on scalp, hair not growing well at site of rash, temperature normal, acting normally.

Children were more likely to be unnecessarily excluded if they attended smaller centers and centers with less experienced directors. However, children were less likely to be excluded at centers with a higher proportion of single mothers and children on state-assisted tuition.

The findings suggest that all child care directors should have regular and ongoing training to reduce the rate of unnecessary exclusion. In the directors' defense, it is sometimes difficult to know when to exclude a child for illness. Child care personnel have to worry about the transmission of infectious illnesses. On the other hand, there is no excuse for not having the APHA/APA guidelines readily available and referring to them often and carefully. It's hard enough to be a working parent without having to find alternative child care for every running nose.